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R LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> � r <br /> Permit Fees: 0H 1114 <br /> ' <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 g <br /> Commercial/Industrial Buildin $300 Addition to Commercial/Industrial Building $200 <br /> Accesso Structu /Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Comme 1) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patios $125 Gazebo Wl Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. u, <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *ltems not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> 'o <br /> ro <br /> Applicant Complete All Sections Below This Line o �. <br /> � z <br /> Applicant's Name: ,(tel, CJG��( � <br /> Applicant's Mailing Address: b 8/ Zc�ty � <br /> City State zip <br /> //__ / z <br /> 6 <br /> Applicant's Telephone Number: 5 f-772-41652— &//` e <br /> Applicant's Email: r]f2I 1 SS Oy Z. <br /> If staff has a question about this application how do you fer to be contacted? Check one below. l <br /> [:]Letterhone ❑Email N 00 <br /> / o <br /> Legal Description: & a, 144 P4,f S (D f A q- t'`�� !A� // <br /> Lot#:_ CSM Vol. Pg. OR <br /> Lot#: 4u �2 / Block#: Subdivision Name: OR N SU <br /> Gov't Lot#: OR 1/4 1/4 F <br /> Section#: Town#: N Range#: W Town of: l <br /> \*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* H <br /> Parcel#(24 digits): D?-0/S-1`. 16 -.24 —S /5—Oq3-0S5eyo d <br /> Tax ID#(1-5 digits): Aro / JL(e[ 7 ,�— <br /> Property Site Address <br /> Road Name:(` Lt) City: /rC Al <br /> T— <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: � <br /> ❑ Single Family Dwelling ❑ Multi-F ily Dwelling 13Filling/Grading Ll Commercial Building <br /> El Single Family Addition Eli-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> m <br /> ❑ Stairs 10 Acc. Structure(Non-bunkhouse) Ll Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition ZO <br /> n <br /> Proposed Structure/Addition Use: C 5 r'Gt -y C <br /> Home/Cabin:Commercial Business:Bed oom:Deck:etc.) n Z Cn m f dll <br /> Building Contractor:_kue ©w n Q/— M -0 U(S <br /> t� v �J <br /> va <br /> Anticipated Start Date: 0 N' <br /> Page 1 of 4 o C <br /> Burnett County, WI Land Use Application-Rev 4/2015 <br /> �— <br /> M <br /> M <br /> M <br />